Provider Demographics
NPI:1275558595
Name:WHITTEN, ROBERT R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:WHITTEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 643398
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3398
Mailing Address - Country:US
Mailing Address - Phone:513-221-1100
Mailing Address - Fax:513-569-5297
Practice Address - Street 1:3825 EDWARDS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1287
Practice Address - Country:US
Practice Address - Phone:513-221-1100
Practice Address - Fax:513-569-5297
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.046346208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0588761Medicaid
OH0588761Medicaid
OHWH0504419Medicare PIN